Causes of Speech Delay

Nam Tong
Sept 2002
Epidemiology
 Peckham 1973:
– unintelligible speech at school age in
• 1.6 % boys
• 0.8 % girls

 Range of normality
Classification
 Multifactorial, much overlap
 Primary speech problem
– voicing, respiratory coordination (stammer),
structural abnormality, neurological
abnormality/ dysfunction
 Secondary speech problem
– dysphasia, global cognitive delay
 Congenital/ Acquired
– tumour, infection, anoxia, injury, haemorrhage
Primary Speech Delay
 Phonological delay (dyslalia)
– male sex, FH, sensory deprivation,
prematurity, slow cerebral dominance,
twins
Primary Speech Delay
 Dysarthria
– Anatomical: cleft palate
– Neurological (bulbar palsy):
• flaccid (dystrophia myotonica, Prader-Willi)
• spastic (cerebral palsy with anoxia)
• extrapyramidal ataxia (kernicterus, CO
poisoning, asphyxia, metabolic disease
Primary Speech Delay
 Dysphonia
– Anatomical:
tumour polyp
cyst vocal cord thickening

– Neurological
recurrent laryngeal nerve palsy
brainstem lesion
vagus nerve lesion (cricothyroid muscle)
Primary Speech Delay
 Dysrhythmia
– festinant
– cerebellar disease
Primary Speech Delay
 (Acquired) Articulatory Dyspraxia
– small lesions in inferior frontal gyrus of
dominant hemisphere
– reduced blood flow in Broca’s area of
premotor cortex
Language Delay
 Expressive Dysphasia (autism,
Asperger’s)
 Receptive Dysphasia
– congenital auditory imperception (Worster-
Drought, 1943)
– central auditory processing disorder/ central
deafness/ auditory agnosia (inability to
discriminate/ recognise/ remember/
comprehend, Keith, Pensak 1991)
• anoxia, Landau-Kleffner, pure word deafness, noise
Language Delay
 Mental Subnormality
– child takes less notice
– poor concentration
– late imitation
– backward in expression and comprehension

 Global Cognitive Delay

– Angelmann’s syndrome, happy puppet
– AD Rolandic epilepsy, speech dyspraxia
Language Delay
 Peripheral deafness
– congenital rubella, CMV, toxoplasma,
syphilis, aminoglycosides, meningitis,
fractures of petrous temporal bone)
Morley 1972 110/280

 Psychosocial deprivation/abuse
– parental rejection, constant criticism/
disapproval, institutions
Language Delay
 Miscellaneous
– Schizophrenia
– Psychomotor epilepsy
– Korsakoff’s psychosis
Summary
 Multifactorial
 Intelligence
 Genetic conditions
 Hearing defects
 Maturation delay/ familial factors
 Environment
 Psychosis
 Brain insult